Monday, June 30, 2008

Heat Building on Schatzberg

When the story originally broke on Dr. Alan Schatzberg's holdings in Corcept Therapeutics and on whether he had properly informed Stanford of this conflict of interest, I assumed the controversy would take on the usual inverted U-shaped curve that these things often do. You know, a lot shocked reactions, some interviews with experts, an official response from the university, and a gradual subsiding of all the commotion into quiescence.

But it doesn't seem to be working out that way, largely because an influential English Professor, Margaret Soltan, has taken up the issue, and has been expressing her outrage in some of the most eloquent writing I've seen on anything, anywhere (she is, after all, an English professor).

Soltan teaches at George Washington University and writes the fascinating blog University Diaries, which is a kind of expose of contemporary university life. She is such a prominent woman of letters that she was featured on PBS's Lehrer News Hour to discuss Dorris Lessing after she won the Nobel Prize in Literature in 2007.

Soltan posted this long article on the affair last Friday, and this short entry today. Friday's posting is notable for Soltan's interesting perspective from the standpoint of a long-time observer of university politics throughout the U.S.; accordingly, she is no stranger to techniques for outflanking regulations:

"So Schatzberg complies with Stanford’s rules when he tells them, as he did, that his holdings in such a company are indeed over that amount [$100,000]. He didn’t need to specify that he stands to earn six million dollars more than that amount. From a drug company he founded."

Soltan realizes that universities can set up conflict of interest policies until the cows come home, but at the end of the day, they have to trust the ethics of their employees:

"For the reality is that universities can set all the conflict of interest standards they like, but a university is not a policing agency. It will always tend to respect, trust, and support its professors in their research, and it will seldom have the investigative capacity to find financial or research wrongdoing, or the judicial capacity to punish it in a serious way. If universities can no longer trust their professors to do honest science and to remain intellectually and morally independent of drug companies, the universities have a couple of choices open to them:

1.] They can hire a permanent team of financial investigators of the sort Grassley has on his staff, and this team can regularly investigate faculty who receive grants and who have financial interests in various companies. Professors would be called in for questioning, their tax documents might be scrutinized, their business associates interviewed. In short, the university can make itself over into a policing agency.

2.] The university can relax and accept the fact that because ” drug makers have displaced the U.S. National Institutes of Health as the primary source of research financing,” some of its professors in the sciences are not professors at all, but contract employees of drug companies. Leave research integrity to the National Institutes of Health; our campus is about enhancing the profits of drug companies and enriching our researchers."

Her post today was short, but to the point. She links to this article by Bernard Carroll, calling it "expert and eloquent testimony against a professor at Stanford University who seems, like Harvard’s Joseph Biederman, to have allowed greed, arrogance, and deception to guide his clinical work. Our function relative to these men, our job as ordinary American citizens, is to:1. subsidize their already commercially subsidized work with our tax dollars;2. buy and take the insufficiently or inappropriately tested medications they’re selling; and3. swallow the stories their universities are telling about their integrity."

Perhaps the most interesting part of Soltan's original article is in the comments section, where Ian Hsu, from Stanford's Public Affairs Office, tries to explain what the heck Stanford was thinking all of these years. Understanding his explanations (in three separate comments) may require that you consult this translation of Bureaucratic Speak.

7 comments:

Yes, but Stanford seems resigned to fighting this tooth and nail. I think Stanford must be hiding something. I wonder how long Stanford had their equity interest in Corcept before selling.

And how many studies did Schatzberg do at Stanford before the university divested from Corcept? There's something not right with their response. Maybe Stanfor is worried about protecting their image with the Board of Directors and their wealthy donors than engaging in ethical medicine.

Dr. Carlat, has Stanford responded by email to any such questions? Their answers just fall flat.

Keep up the heat on this matter; I think it's bigger than anyone could imagine in the end. This guy is to be APA President next year, so if physicians, expecially psychiatrists, really care about how this is handled reflects on us as an entity and how the public will trust us in future times, zero tolerance for greed and selfishness, especially in a training program setting, has to be maintained.

Any thing less, and we are truly the whores and cowards I have come to believe we have become unless the majority of my peers rise and show me wrong. This matter is of this magnitude.

Duke has long been the model of the "profit center" CME Department. How much they have had to "look the other way" in order to hide faculty conflicts, could tell us what the Stanford leadership is thinking about its "mandate" to make money for the school and at what cost. Is there any Duke faculty out there that can comment and, perhaps, shed light on this perplexing situation?

As a member of the APA, it is very disconcerting to know that this kind of corruption goess clear to the top. Schatzberg should step down and decline the presidency of the APA. And if he doesn't, I'll be the first to sign a petition urging that he do so. Tossing him out would be a good first step in the house-cleaning process.

While the circumstances are certainly different, physicians painted as financial "overnight sensations" are not entirely new. In 1999, I wrote a story about C. Everett Koop, MD, and his fall from grace as spokeman for www.drkoop.com -- which was to be the Medscape of its time. (http://brainscienceblogs.com/koop-article/)A pediatric surgeon who trained and spent much of his career at the University of Pennsylvania School of Medicine, Koop became US Surgeon General in 1981. As surgeon general he advised the public on a wide variety of health matters, including smoking hazards, diet and nutrition, immunization and disease prevention, and the then-emerging disease known as AIDS.

At the age of 82, drkoop.com went public in an $84.4 million initial public offering, netting the good doctor stock in excess of $47 million—“monopoly money” as he casually referred to the bonanza from his Dartmouth, NH, headquarters. How a man born in Brooklyn, NY, in 1916, became a symbol for the modern, electronic age of health-care delivery, was, well, confounding. Not surprising was that the folks he teamed-up with became overly ambitious and drkoop.com was shut down for various allegations of impropriety before the grandfatherly Koop could collect one dime.

What he said to me then is freaky in 20:20 hindsight. “We have a brand name and that is very important. When I had the privilege of being surgeon general, I was a straight shooter, so patients know they’ll get a straight answer.” As the story goes, we never did get that straight answer.